PORTLAND, Oregon. (AP) – The role that race should play in deciding who has priority for the COVID-19 vaccine was tested on Thursday in Oregon, but people of color will not be the specific focus in the next phase of the state’s deployment as tensions around equity and access for the shots emerge across the country.
An advisory committee providing recommendations to Governor Kate Brown and public health officials discussed whether to prioritize racial minorities, but decided on a wide range of other groups: under 65 with chronic medical conditions, essential workers, prison inmates and people living in groups.
The 27-member panel in Oregon, a Democratic-led state that is predominantly white, said people of color are likely to fall into other prioritized groups and expressed concerns about legal issues if race were the focus. Their recommendations are not binding, but they do offer important guidance on vaccine distribution.
The committee was formed to keep justice at the heart of Oregon’s vaccine implementation. Its members were selected to include racial minorities and ethnic groups, from Somali refugees to indigenous peoples.
“Our system is not yet ready to focus and reveal the truth of structural racism and how it works,” said Kelly Gonzales, a member of the Cherokee Nation of Oklahoma and an expert on health disparities on the committee.
The panel included a statement in its plan recognizing the impact of structural racism and saying that it reviewed the needs of minority communities.
The virus disproportionately affected black people. Last week, the Biden government again emphasized the importance to include “social vulnerability” in state vaccination plans – with race, ethnicity and rural-urban division in the foreground – and asked states to identify “pharmacy deserts” where vaccines would be difficult to obtain.
Overall, 18 states included ways to measure equity in their original vaccine distribution plans last fall – and most likely have since the vaccines started arriving, said Harald Schmidt, a medical ethics expert at the University of Pennsylvania who studied extensively the justice of the vaccine.
Some, like Tennessee, have proposed to allocate 5% of their allocation to “areas of high disadvantage”, while states like Ohio plan to use social vulnerability factors to decide where to distribute the vaccine, he said. California has developed its own metrics to assess the level of need for a community, and Oregon is doing the same.
“We have been telling a very simple story: ‘The vaccines are here.’ Now we have to tell a more complicated story, ”said Nancy Berlinger, who studies bioethics at The Hastings Center, a non-partisan and independent research institute in Garrison, New York. “We have to think about all the different overlapping risk areas, and not just the group we belong to and our personal network.”
Attempts to address inequalities in access to vaccines have already generated reactions in some places. Dallas officials recently reversed the decision to prioritize the most vulnerable postal codes – especially communities of color – after Texas threatened to cut the city’s vaccine supply. This type of resistance tends to become more pronounced as states deepen their implementation and grapple with difficult questions about the need and lack of supply.
To avoid legal challenges, almost all states that consider race and ethnicity in their vaccine plans are turning to a tool called the “social vulnerability index” or “handicap index”. This index includes more than a dozen data points – everything from education income, health outcomes and car ownership – to target disadvantaged populations without specifically mentioning race or ethnicity.
In doing so, the index includes many minority groups because of the impact of generations of systemic racism, while collecting people at a socioeconomic disadvantage who are not people of color and avoiding “very, very difficult and toxic issues” about race, he said. Schmidt.
“The point is not, ‘We want to make sure that the Obama family gets the vaccine before the Clinton family.’ We don’t care. Both can safely wait, ”he said. “We care that the person working in a refrigerator in a crowded situation understands first. It’s not about race, it’s about race and disadvantage. “
In Oregon, health leaders are working on a social vulnerability index, including analyzing data from the United States census and then analyzing things like occupational status and income levels, said Rachael Banks, director of the health division public health of the Oregon Health Authority.
This approach “goes beyond an individual perspective and to a more community perspective” and is better than asking a person to prove “how they fit into any demographic group,” she said.
This makes sense to Roberto Orellana, a professor of social work at Portland State University, who launched a program to train his students to track contacts in Hispanic communities. The data shows that Hispanics are about 300% more likely to contract COVID-19 than their white counterparts in Oregon.
Orellana hopes that her students, who are interning at state agencies and organizations, will be able to put their knowledge to use both in contact tracking and in the defense of vaccines in communities of migrants and agricultural workers. Vaccination of essential workers, prisoners and people in multigenerational families will reach people of color and put them at the center of the vaccination plan, he said.
“I don’t want to take it out of any other group. It is a difficult, difficult question, and each group has valid needs and concerns. We shouldn’t be going through this, ”said Orellana. “We should have vaccines for everyone – but we are not there.”
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Associated Press / Report for America Statehouse News Initiative, member of the Sara Cline body, contributed to this report. Follow Flaccus on Twitter at http://www.twitter.com/gflaccus.